Namibia Ultra Marathon

INJURIES

Running injuries are almost inevitable for anyone running frequently, far and hard. On the positive side, most running injuries are short-term (if you recognise the symptoms early enough and take appropriate action to recover). There is a lot of information available on how to recognise symptoms and avoid injury. We have listed a few of the most common injuries later in the chapter, but the best thing would obviously be to avoid getting injured in the first place. 

STAYING INJURY FREE The following advice will help you to avoid injury whilst training:

Train on a good surface - the most suitable running surfaces are firm but not too hard and relatively flat. Roads are generally good for running as they will offer a pretty flat surface with (hopefully) no pot holes or uneven areas. If you do train on the road, make sure you are visible and run against the flow of the traffic. Running on different surfaces can help to prevent injuries. 

Training long distances solely on roads can be very hard on your muscles and joints, so alternative cross country routes can offer some light relief for your legs. Off-road running will also help to prepare you for the varied surfaces you will face during the race. Mix some road with cross country running and you should find you ache a little less after a hard session. Do be cautious when running off road – try to find a well trodden path and watch out for dips and holes as they may cause you to twist or sprain your ankles. 

Wear suitable running shoes – as we mention in the training section, your running shoes are the most important piece of equipment when you are running, so make sure you choose a pair that is right for your feet, and for your training regime. There are loads of different types of running shoes to choose from – get advice from a good running shop and make sure the trainer has good cushioning in the heel cup and mid-sole. Old worn out trainers with little or no cushioning will not have good shock-absorbing capacity and can cause a number of injuries, so make sure you replace old running shoes before it is too late! 

Warm up and stretch before you exercise – the aim of the warm up is to increase your body temperature, in particular warming your muscles, before you begin your exercise. A warm up could involve just taking a warm shower to increase your temperature, but more commonly it would include activities such as lifting light weights or jogging. The warm up will not only increase your body temperature but also increase respiration and circulation causing your muscles to warm and become more flexible. Muscles are more prone to tearing if the body has not sufficiently warmed up before beginning rigorous exercise. 

Tight muscles hurt, perform less efficiently and are more prone to injury so stretching before your work out will improve flexibility. The more you strive to prevent muscle tiredness, the better off you will be. It is also a good idea to stretch when you have finished training to increase general muscle flexibility. 

Recognise early injury signs and takeaction – running injuries are almost always gradual, so if you feel a niggling pain, don’t ignore it as it will usually get worse. There are generally four stages to an injury: 

Stage 1 – pain is felt some hours after completing exercise.

Stage 2 –discomfort felt during exercise but is not uncomfortable enough to stop you training at your usual pace.

Stage 3 – Severe discomfort is felt – pain during exercise causes you to reduce training intensity

Stage 4 – Pain too intense, you are no longer able to train. 

As soon as you experience the first sign of injury, try to identify where the problem may have originated (old trainers, running on unsuitable surface causing twisting etc) and take the appropriate action. You may need to consult your doctor – don’t wait until you reach stage 4 of your injury before speaking to a doctor, as this will require more severe treatment than if you had sought advice earlier. You may simply need to reduce the impact of your training for a while, or take a rest day for the injury to ease. 

COMMON INJURIES

Paying attention to and taking proper care of your body can be the key to completing an adventure race. If you follow the above advice, you will lesson the probability of injury. However, when you are following a strict training regime and running for long distances over a long period, injuries are almost inevitable. The following are some of the most common injuries suffered by runners, along with tips on how to avoid them, diagnose and treat them. 

BLISTERS

Blisters are a common problem for marathon runners, particularly when new running shoes or socks are being broken in. 

Prevention:

Blisters can be avoided, so here are a few tips on how to stay blissfully blister free:

Wear well fitting footwear – key to avoiding blisters. Make sure your trainers are not too tight, not too loose. Ideally on race day wear a well worn and trusted pair of running shoes. A pair of liner socks can help to ensure the shoe fits comfortably and helps prevent friction on your foot. 

Keep your feet dry – easy to say not so easy to do when running a marathon in the desert! Although adventure racing is not conducive with dry feet, if you can keep your feet as dry as possible it will help to prevent blisters from developing. Wet feet, trainers and socks will cause blisters much quicker than dry ones. Use foot powder to help keep your feet dry, and take spare socks on the run with you, so you can change in to dry socks where possible. 

Protect ‘hot spots’ – to avoid full blister development. If you start to feel a hotspot, don’t wait until you reach the next water station before taking action – treat it immediately to prevent it from getting worse. Stop running and apply a second skin or blister plaster to the affected area. Dry your feet and, if possible, put some dry socks on. 

Treatment:

If you find you have developed a blister, again you should treat it immediately. If the blister is large and full of liquid, try to clean the skin around it and gently puncture the skin to drain it. Do not drain a blood filled blister. Try to drain the fluid without disturbing the skin, so as much skin as possible still covers the wound. This provides an important protective layer and will help prevent infection. Place some moleskin or compeed blister treatment over the blister, then place leucotape over the top to secure it well. If you find the blister very painful, do stop at the next water station and one of our doctors will have a look and treat it for you. 

ACHILLES TENDONITIS

Achillies tendonitis is relatively common in marathon runners – around 11% of all running injuries are attributed to this condition. The Achilles tendon is the large tendon at the back of the ankle that connects your calf muscles to the heal bone, providing the power for the pushing off movement of the foot when walking. The tendon can be slow to heal if it becomes inflamed because it has a very poor blood supply. 

Prevention:

Don’t train too hard – overuse of the Achilles tendon through training too hard, too soon causes a strain on the tendon. Be aware of signs of over-training and try to avoid the temptation to push yourself if your body is not ready. 

Careful when running uphill – uphill running stretches the tendon more than on a normal running movement. Be aware that when training on hills the tendon will become tired more quickly than usual. 

Correct foot pronation – if your foot rolls inwards or outwards when running, extra strain is put on the Achilles tendon. As the foot rolls inwards, the lower leg rotates inwards and this in turn twists the Achilles tendon, causing twisting stresses as well as stretching the tendon. Try to get training shoes that help to correct the foot pronation. 

The first sign that you have Achilles tendonitis is usually when you step out of bed in the morning and you get a feeling of stiffness at the back of the ankle. This feeling usually wears off once you have walked around a little. You can diagnose Achilles tendonitis by recognising that the discomfort you feel is situated in the tendon area and if you pinch the area between your thumb and index finger you will be able to locate tender areas. If left untreated, the problem can worsen, progressing to a gradual build up of pain during prolonged exercise which remains during rest periods. 

Treatment:

The cause of the problem is due to degeneration of the tendon, rather than inflammation, so the sooner you rest and take action to treat the tendon, the better. Don’t take anti-inflammatory medication and expect the pain to go away! If you suffer from the symptoms of Achilles tendonitis, rest your foot until the pain eases and apply ice to the area. Massaging and gently stretching the tendon will prevent it from shortening during recovery. You may also wish to try wearing a heel pad to raise the heel and take some of the strain off the tendon. You should only use the pad as a temporary measure whilst the tendon is healing. 

You should seek medical advice if the pain continues. Although you should stop running during the recovery period, you can replace this exercise with some swimming, cycling or upper body training which will help you to continue with your training without putting more strain on the tendon.

If you look after this injury early enough you should make a good recovery, and could heal within a few days. It is important you rehabilitate the tendon properly after it has recovered or the injury will return. If you ignore the early warning signs and do not treat the injury at the acute stage, it could progress on to chronic tendonitis – which is much more difficult to treat and could cause the injury to worsen to the point of making running impossible. 

RUNNERS KNEE (PATELLOFEMORAL SYNDROME)

Runners knee is the most common injury suffered by regular and distance runners. Until very recently the injury was thought to be caused by damaged cartilage tissues which line the knee joint between the kneecap and the two other bones (tibia and femur) which make up the knee joint. When the knee is bent from being outstretched, a number of muscles and ligaments which attach to the patella serve to move it towards the inside surface of the knee and sit in the notch of the femur. 

It was only in the early 1980’s that a group of surgeons noted that the injury is not a degeneration of the cartilage, but damage to the ligaments around the knee joint, and in some cases the bone, showed degenerative changes. 

In general, patellofemoral pain syndrome occurs when the patella does not move or 'track' in a correct fashion when the knee is being bent. This movement can lead to damage of the surrounding tissues leading to pain in the region. Some of the causes leading to an abnormal movement of the patella are as follows: 

Overloading – bending the knee increases the pressure between the patella and the femur. Since running involves repeated weight-bearing bending of the knee, the pressure on the area increases and can result in patellofemoral syndrome. 

Pronating feet – feet that are ‘flat’ or roll inwards or outwards during running can lead to an increased stress on the knee joint as the pronation may affect the alignment of the patella during movement. 

Muscle imbalance – the quadriceps muscle group are responsible for the movement of the patella. If the outer muscles are stronger or tighter than the medial fibres, or if the iliotibial band is very tight, it can lead to irregular tracking of the patella. 

Large femoral angle – some people have a larger than normal femoral angle (also known as the Q-angle) – usually noted with a ‘knock-kneed’ appearance. When the leg is straight, the patella is forced to the outside of the knee. Repeated weight-bearing loads can cause damage to the underlying structures and cause pain. 

The first indication you will get of this injury is a localised pain around the kneecap – usually first felt whilst running. 

The main characteristics of the injury are as follows:

Aching pain in the knee joint, particularly at the front around and under the patella

Pain under the patella when bending and straightening the knee Tenderness along the inside border of the kneecap

Swelling is often visible

Painful to sit for long periods – this is known as the theatre sign

Walking up or down hills and stairs is particularly painful. 

Treatment:

Recognition of the injury at an early stage and taking rest to reduce stress being put on the area should allow it to begin healing. Place ice on the painful area for about 20 minutes twice a day. When the knee is bent the forces under the knee cap are increased, so exercises which involve full bending of the knee should be avoided. Strengthening the vastus medialis muscle (the muscle that helps to stabilise the kneecap during tracking) can be helpful. This can be done by using the ‘chair squatting stretch’. From a standing position, keep both heels planted on the floor and lower your bottom into a squatting position as though you are about to sit on a chair – do not lower further than a 90o angle. Hold the position, but if you have any pain in the knee or leg stop immediately. 

Look at the position of your feet when you run – if you over or under pronate, look for training shoes that offers good stability and anti-pronation features. 

You should only begin to run again when you no longer feel the pain during movement. When you do begin to run again, wear a good knee support and avoid down-hill running as this places extra weight and stress on the area. 

CHAFING

Not the most glamorous of injuries, but a very common problem for runners. Chafing is usually caused when an item of clothing continuously rubs against damp, sweaty skin until it is rubbed away and you begin to bleed. Chafing generally takes place around the groin, underarms and nipples, but it can occur anywhere. 

Prevention:

There are four main actions that should be taken in order to avoid chafing: 

Close-fitting clothing – decreases the possibility of rubbing. Loose clothing allows seams to move and rub. Avoid clothing with seams where possible, particularly shorts in the groin area. Avoid wearing new clothes during a race as materials will be stiffer and more prone to chafing. 

Try to stay dry – use talcum powder to dry the areas that may be prone to chafing. If this fails, consider using a lubricant to protect the area from rubbing. Avoid using roll-on deodorants under the arms, as they are often sticky and can worsen the problem. If you suffer from chafing it may be worth taking some talcum powder with you during the race to help dry any sweaty areas. Clothing should be made of a wicking material which will help to move the moisture away from your body and keep it dry. 

Keep well hydrated – drink lots of water during training and after exercise. If your body lacks fluids, perspiration may turn into salty crystals which increases the possibility of chafing. 

Lubrication – There are a number of lubricants available which help skin-on-skin areas to slide over each other rather than rubbing together. Petroleum jelly (or Vaseline) are old favourites. This can also be used on your feet and toes to help avoid blisters. 

Treatment:

If you do unwittingly fall prey to chafing, treat it as you would an open wound. Wash it clean with antiseptic to prevent it becoming infected and cover with a gauze pad which will allow the area to breathe whilst healing. The most painful chafing, and the most difficult to treat is the nipple area. This area is particularly uncomfortable as it stays tender for a much longer time, and it is more likely to bleed. Treat this area with particular care. If clothing and lubrication do not help, consider wearing plasters over the nipples during exercise.

EXERCISE-INDUCED DIARRHOEA (popularly known as runner’s trots!)

For some reason, long distance running often has a major effect on a runners’ bowels. In fact, between 20 and 50% of distance runners suffer either to a greater or lesser extent from ‘runners trots’. Symptoms range from stomach cramping and nausea to wind and diarrhoea. There is very little understanding of why runners’ trots occur, even though so many people are affected. One theory is that the flow of blood is diverted to your legs during running and away from the intestines, possibly triggering the cramps and/or diarrhoea. 

The primary symptoms of runner’s trots are cramping, nausea, flatulence and diarrhoea during or after exercise. The unfortunate thing about this problem is that it may produce painful cramping and the compulsory need to defecate – even if you are in the middle of a run on a main road you may not be able to resist the urge! 

Prevention:

Avoid caffeine and warm fluids – don’t drink caffeine or warm fluids before running as they speed up the movement of wastes through the intestines. 

Be aware of food intake – limit high fibre foods, or foods which you know tend to produce flatulence or diarrhoea. Avoid eating within an hour or so of training as the presence of food in the stomach will contribute to the problem. 

Drink plenty of fluids – drink lots of water an hour before your train – the excess fluid will pass through before you head out, and your body will be well hydrated from the start.

Treatment: 

Unfortunately, there is no available treatment for this problem. There are no toilets on the race route, so everyone will have to make toilet stops in the wild. If all other prevention efforts fail, it may be worth talking to your doctor about the use of over-the-counter anti-diarrhoea products such as Imodium. This is certainly not recommended for every day treatment, but it may help to prevent you having to stop behind every available rock during the race! 

Namibia Ultra Marathon

Across the Divide

Desert Medicine Training Course - Namibia